Project Summary There is a critical need to study innovative strategies to better engage populations of people most at risk of glaucomatous vision loss and least likely to have access to an eye care provider. Community clinics such as federally qualified health centers or free clinics provide care for people who live in poverty. Because these people are disproportionately of minority race and ethnicity, community clinics provide care for people who are at higher risk of: 1) having glaucoma and 2) not getting adequate specialty treatment for glaucoma. Glaucoma remains a leading cause of blindness even though effective treatments exist. Our objective is to address the critical logistical and psychosocial barriers ? cost, transportation, trust in the provider and skepticism that that an asymptomatic disease will lead to blindness ? that limit access of vulnerable populations to glaucoma care. The scientific premise is based on evidence of the effectiveness of telemedicine approaches to glaucoma screening that have improved access to services for vulnerable populations. Our central hypothesis is that providing comprehensive glaucoma screening and follow-up care through the community-based free clinic infrastructure will establish a sustainable approach to decreasing logistical and psychosocial issues and improve vision outcomes for this vulnerable population. We will use community-engaged research strategies to understand key barriers to accessing eye care for uninsured and underinsured adults through semi-structured interviews. We will build upon a trusting partnership among academic (University of Michigan, UM) and community clinics (Hope Clinic, Ypsilanti, MI and Hamilton Clinic, Flint, MI) by forming a Community Advisory Board to engage these communities in glaucoma screening efforts. We will use a telemedicine-based glaucoma screening approach in the two clinics. Ophthalmic technicians will gather automated eye screening data at the clinic sites and transmit the data to an ophthalmologist at the UM who interprets screening information and conveys recommended follow-up care remotely. Ophthalmologist resources will be used more efficiently, since they do not need to be co-localized with the patient to provide high quality screening care. The burden on patients? time is also reduced. Screening is conducted locally at trusted locations, and only patients who screen positive for disease travel to specialty clinics. Low-cost glasses will be provided through publicly available infrastructure. We will assess the prevalence of glaucoma and other blinding eye diseases and the screening cost per case detected. We will use community input to refine an eHealth-based personalized counseling and education program to improve adherence to glaucoma follow-up care recommendations. We will evaluate the effect of this intervention on follow-up adherence compared to standard education in a randomized controlled trial. Programmatic costs will be evaluated. This proposal is a first step toward our long- term goal to eliminate disparities in glaucoma outcomes by leveraging community-engaged research to bring specialty care to vulnerable populations.